7/25/2017 American Academy of Ophthalmology IRIS Registry (Intelligent Research in Sight) Analytics Data Dictionary Disclaimer: This data dictionary covers the data elements found within the American Academy of Ophthalmology IRIS Registry (Intelligent Research in Sight). The IRIS Registry database is comprised of de-identified data extracted from participating ophthalmology practices electronic health records (EHRs,) and data completeness may vary depending on the data element for a number of reasons including if the element is routinely captured in an EHR, clinician documentation patterns, and differences in the structure of EHRs. Some data elements, for example patient medical history, patient ocular history, complications of treatment, etc., that are not specifically outlined in the data dictionary can be identified when they are documented in the record, but are not individual elements in the IRIS Registry database. There may be additional data elements collected by the IRIS Registry which are not captured in this data dictionary. Investigators are not necessarily restricted to only the elements outlined in this data dictionary, as we have the ability to mine other data fields included in electronic health record systems.
Element ID: 1 Patient Demographics Name: Year of Birth Format: Date (YYYY) 1890 current year none Missing: 2.8% Element ID: 2 Name: Is deceased? (categorical) True False Element ID: 3 Name: Year of Death Format: Date (YYYY) Element ID: 4 Name: Provider Zip code Format: Numerical Date: 7/25/2017 1 Version: 2.0
Element ID: 5 Patient Demographics Name: Gender Format: Numerical (categorical) 1 Male 2 Female None Missing: 2.8% Element ID: 6 Name: Race-White Format: Numerical (categorical) White (Race) Having origins in any of the original peoples of Europe, the Middle East, or North Africa. Source: U.S. Office of Management and Budget. Classification of Federal Data on Race and Ethnicity Date: 7/25/2017 2 Version: 2.0
Element ID: 7 Patient Demographics Name: Black/African American Format: Numerical (Categorical) Black/African American (Race) Having origins in any of the black racial groups of Africa. Terms such as "Haitian" or "Negro" can be used in addition to "Black or African American." Source: U.S. Office of Management and Budget. Classification of Federal Data on Race and Ethnicity Element ID: 8 Name: Asian Format: Numerical (Categorical) Asian (Race) Having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. Source: U.S. Office of Management and Budget. Classification of Federal Data on Race and Ethnicity Date: 7/25/2017 3 Version: 2.0
Element ID: 9 Patient Demographics Name: Race-American Indian/Alaskan Native Format: Numerical (Categorical) Race-American Indian/Alaskan Native (Race) Having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment. Source: U.S. Office of Management and Budget. Classification of Federal Data on Race and Ethnicity Element ID: 10 Name: Race-Native Hawaiian/Pacific Islander Format: Numerical (Categorical) Race-Native Hawaiian/Pacific Islander (Race) Having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. Source: U.S. Office of Management and Budget. Classification of Federal Data on Race and Ethnicity Date: 7/25/2017 4 Version: 2.0
Element ID: 11 Patient Demographics Name: Hispanic or Latino Ethnicity Format: Numerical (Categorical) Hispanic or Latino Ethnicity A person of Cuban, Mexican, Puerto Rican, Cuban, South or Central American, or other Spanish culture or origin, regardless of race. The term, "Spanish origin," can be used in addition to "Hispanic or Latino." Source: U.S. Office of Management and Budget. Classification of Federal Data on Race and Ethnicity Element ID: 12 Name: Insurance- Private Health Insurance Format: Numerical (Categorical) Private Health Insurance Private health insurance is coverage by a health plan provided through an employer or union or purchased by an individual from a private health insurance company. Source: U.S. Census Bureau Date: 7/25/2017 5 Version: 2.0
Element ID: 13 Patient Demographics Name: Insurance- Medicare FFS (Part B) Format: Numerical (Categorical) Medicare: Medicare is the Federal program which helps pay health care costs for people 65 and older and for certain people under 65 with long-term disabilities. The traditional system of reimbursement under health insurance and Medicare. Health care providers bill patients for services supplied, and costs are shared according to a contractual agreement between the patient and insurance company. A feefor-service system allows patients maximum flexibility in the choice of providers and services. Source: U.S. Census Bureau Element ID: 14 Name: Insurance-Medicare Managed Care (Advantage Plans) Format: Numerical (Categorical) Medicare Advantage: A type of Medicare health plan offered by a private company that contracts with Medicare to provide [beneficiaries] with all Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. Source: Medicare.gov Date: 7/25/2017 6 Version: 2.0
Element ID: 15 Patient Demographics Name: Insurance-Medicaid Format: Numerical (Categorical) Medicaid: Medicaid is a program administered at the state level, which provides medical assistance to the needy. Families with dependent children, the aged, blind, and disabled who are in financial need are eligible for Medicaid. It may be known by different names in different states. Source: U.S. Census Bureau Element ID: 16 Name: Insurance-Military /Department of Defense/TRICARE Format: Numerical (Categorical) Military Health care: Military health care includes TRICARE/CHAMPUS (Civilian Health and Medical Program of the Uniformed Services) and CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs), as well as care provided by the Department of Veterans Affairs (VA). Source: U.S. Census Bureau Date: 7/25/2017 7 Version: 2.0
Element ID: 17 Patient Demographics Name: Insurance- Other Government- State/Local government; Indian Health Service Format: Numerical (Categorical) State-specific plan - Some states have their own health insurance programs for low income uninsured individuals. These health plans may be known by different names in different states. (Non-Medicaid) Indian Health Service (IHS)- is a health care program through which the Department of Health and Human Services provides medical assistance to eligible American Indians at IHS facilities. In addition, the IHS helps pay the cost of selected health care services provided at non -IHS facilities. Source: U.S. Census Bureau Element ID: 18 Name: Insurance- Miscellaneous/Other-Foreign National, Worker s Comp, Auto Insurance (Categorical) Date: 7/25/2017 8 Version: 2.0
Element ID: 19 Patient Demographics Name: Insurance- No Insurance/Payment Listed (Categorical) Element ID: 20 Name: Insurance Coverage Role Type The individuals covered according to the Insurance Plan subscribed by the patient. For example, Child, Spouse, Wife etc. Element ID: 21 Name: Insurance Effective Date Format: Date (Week#) (Week#x/yyyy) Date on which the Insurance date is documented in EMR/HER Element ID: 22 Name: Immunization Date (week#) Format: Date Week#x/yyyy Date: 7/25/2017 9 Version: 2.0
Element ID: 23 Patient History Name: Immunization Type Format: Numerical CPT Element ID: 24 Name: Patient Allergy Description Description for an allergy for a patient extracted from EMR/EHR. Element ID: 25 Name: Patient Allergy Event Type The type of an allergy documented in the EMR/EHR. For example, Food Allergy, Drug Allergy etc. Element ID: 26 Name: Patient Allergy Reaction The type of reaction occurring due to an allergy b eing documented in the EMR/EHR. For example, Rash, Itching etc. Element ID: 27 Name: Patient Allergy Status This field contains the status of an allergy for a patient extracted from the EMR/EHR. For example, Active\No Longer Active. Date: 7/25/2017 10 Version: 2.0
Element ID: 28 Patient History Name: Allergy Resolution Date Format: Date (Week#) Week#x/yyyy The date on which the allergy for a patient is resolved and is documented into the practice EMR \EHR. Element ID: 29 Name: Date Allergy First Encountered Format: Date (Week#) Week#x/yyyy The first encounter date on which the allergy for a patient is documented\saved in the practice EMR\EHR. Element ID: 30 Name: Social History Observation Social History Observation code documented in the EHR/EMR. Element ID: 31 Name: Social History Observation Name Social History Observation Name extracted from the EMR/EHR. For example, Smoking, Alcohol etc. Date: 7/25/2017 11 Version: 2.0
Element ID: 32 Patient History Name: Social History Observed Value Format: Numerical (categorical) The actual value of the documented observation which is extracted from EMR/EHR. ex. Former Smoker, Never Smoker, Drinks etc. Tobacco use is missing: 10.0% Element ID: 33 Name: Social History Observation Status The current status of the documented observation. For example, Active, No Longer Active etc. Element ID: 34 Name: Social History Type Text The type being documented against respective social history observation. For Example, Smoking, Alcohol etc. Element ID: 35 Name: Social History Start Date Format: Date (Week#) Week#x/yyyy Social History Observation code documented in the EHR/EMR. Element ID: 36 Name: Social History End Date Format: Date (Week#) Week#x/yyyy The end date on which the social history observation for a patient is stopped. (To Date) Date: 7/25/2017 12 Version: 2.0
Element ID: 37 Clinical Examination Findings Name: Visit UID Format: Numerical Uniquely identifies an Encounter\Visit for a patient Element ID: 38 Name: Visit Format: Numerical The code assigned to a visit Element ID: 39 Name: Visit Date Format: Date (Week#) Week#x/yyyy The encounter date documented for a visit in an EMR/EHR. Element ID: 40 Name: Visual Acuity Date (week#) Format: Date Week #x / YYYY Date: 7/25/2017 13 Version: 2.0
Element ID: 41 Clinical Examination Findings Name: Visual Acuity Type (categorical) Corrected Visual Acuity Uncorrected Visual Acuity Unspecified Element ID: 42 Name: Visual Acuity Method Format: Numerical (categorical) 1 Near 2 Distance 3 Pinhole 4 Manifest Refraction 5 Unspecified 6 Near, Pinhole 7 Distance, Pinhole 8 Manifest Refraction, Distance 9 Manifest Refraction, Near 10 Manifest Refraction, Pinhole 11 Near, Cycloplegic Refraction Date: 7/25/2017 14 Version: 2.0
12 Distance, Cycloplegic Refraction 13 Near, Automated Refraction 14 Distance, Automated Refraction Pinhole cannot be converted to LogMAR Element ID: 43 Name: Visual Acuity Laterality (categorical) OD= Right OS= Left OU= Both Element ID: 44 Name: Visual Acuity Format: Numerical Snellen, Jaeger AAO can convert Snellen to LogMAR Element ID: 45 Name: Cup to Disc Ratio Date (week#) Format: Date Week #x/yyyy Date: 7/25/2017 15 Version: 2.0
Element ID: 46 Clinical Examination Findings Name: Cup to Disc Value Format: Ratio 0.01-0.99 Element ID: 47 Name: Cup to Disc Laterality (categorical) OD = Right OS = Left OU= Both Element ID: 48 Name: Intraocular Pressure Date (week#) Format: date Week #x/yyyy Date: 7/25/2017 16 Version: 2.0
Element ID: 49 Clinical Exam Findings Name: Intraocular Pressure Laterality (categorical) OD= Right OS= Left OU= Both Element ID: 50 Name: Intraocular Pressure Measurement Format: Numerical mmhg Date: 7/25/2017 17 Version: 2.0
Element ID: 51 Diagnoses, Procedures and Medications Name: Procedure Date (week#) Format: Date Week#x/yyyy Element ID: 52 Name: Procedure Laterality (categorical) 1 OD (Right) 2 OS (Left) 3 OU (Both) 4 Unspecified Element ID: 53 Name: Procedure Format: Numerical CPT HCPCS This also includes modifiers if available. Element ID: 54 Name: Diagnosis Date (week#) Format: Date Week#x/yyyy Supporting : The date on which the disease for a patient is documented\saved in the practice EMR\EHR. Date: 7/25/2017 18 Version: 2.0
Element ID: 55 Diagnoses, Procedures and Medications Name: Resolution Date for Acute Conditions (week#) Format: Date Week#x/yyyy Supporting : The date on which the disease for a patient is resolved and is documented into the practice EMR\EHR. Element ID: 56 Name: Diagnosis Laterality Format: Numerical (categorical) 1 OD (Right) 2 OS (Left) 3 OU (Both) 4 Unspecified Date: 7/25/2017 19 Version: 2.0
Element ID: 57 Diagnoses, Procedures and Medications Name: Diagnosis Format: Alphanumerical ICD 9 ICD10 SNOMED Based on diagnosis codes and diagnosis date, AAO can determine past ocular history, past ocular systemic history, current diagnosis and complications of treatment. Element ID: 58 Name: Medication Format: Numerical RX Norm, NDC codes, Generic Product Identifier (GPI) Element ID: 59 Name: Medication Name Drug name extracted from EMR/EHR Element ID: 60 Name: Medication Dose Format: text Examples: drops, mg, ml, Date: 7/25/2017 20 Version: 2.0
Element ID: 61 Diagnoses, Procedures and Medications Name: Medication Route Format: text Examples: Ophthalmic, oral, inhalation, nasal, etc. This field describes the medication route for a medication which is extracted from the EMR/EHR. For example, Injection, Mouth etc. Element ID: 62 Name: Medication Frequency Format: text Examples: daily, twice a day b.i.d, etc. Element ID: 63 Name: Medication Start Date (week#) Format: date Week#x/yyyy Element ID: 64 Name: Medication End Date (week#) Format: date Week#x/yyyy Date: 7/25/2017 21 Version: 2.0
Element ID: 65 Diagnoses, Procedures and Medications Name: Prescribed Electronically True False Describes if the prescription is electronic or not. Element ID: 66 Name: Medication Status This field contains the current status for a medication. For example, Active, Inactive etc. Element ID: 67 Name: Medication Product Form The prescribed form for the medication. For example, Tablet, capsule, Liquid etc. Date: 7/25/2017 22 Version: 2.0
Element ID: 68 Plan of Care Name: Patient Plan of Care Description Description for a documented plan of care extracted from the EMR/EHR Element ID: 69 Name: Instructions Free text field in an EMR/EHR which holds the details for the plan care. Element ID: 70 Name: Plan of Care Name Plan of care name according to the data documented in EMR/EHR Element ID: 71 Name: Plan of Care Group Plan of Care Group according to the care assigned by a provider and documented into the EHR/EMR Element ID: 72 Name: Plan of Care Status The current Status for the documented plan of care. For example, In Process, Ordered etc. Date: 7/25/2017 23 Version: 2.0
Element ID: 73 Plan of Care Name: Plan of Care Effective Date Format: Date (week#) Week#x/yyyy Date on which the PlanOfCare is documented in an EMR/EHR. END Date: 7/25/2017 24 Version: 2.0